[Question #5636] Follow up to #5580 -- still unsure about condition

21 months ago
Hi Doctor,

Thanks to Doctor Hunter for answering my previous concerns. I've tried to settle on that it was anxiety, but symptoms kept persisting even after a lot of meditation and calming myself. These symptoms are:

- continuous uneasiness in lower abdomen and now spreading to side of the hip
- burning sensation at the tip of penis and also slightly more red than normal
- sensitive balls 
- warm sensation when peeing and ejaculating
- increased heart rate 

I've then gone to another urologist here in Manila and he ordered new urinalysis and put me on cefuroxime (7 days) thinking it may be UTI. However when tests came back it showed I was positive for Gardnerella Vaginalis. I was a bit surprised by this as it shows that Men cannot contract this from women? And that it may be a sign of something else? As this urologist went on vacation I was referred to his replacement -- he then shot injection of antibiotics in my butt and put me on 4 tablets of Azithromycin and then a final 4-pill metronidazole which I'm supposed to take at once this Saturday. He explained this was "empirical treatment"

I'm now on the 3rd day of taking the azithromycin but don't feel any improvement  ...

My questions are:

- It's been 4 weeks since the protected intercourse with the spa attendant, as I mentioned I had a HIV test done 9 days after that occurrence which came back negative. Do you think I need to worry still about HIV being a cause for my symptoms? I didn't have any fever so far
- If the final dose of metronidazole doesn't clear up my symptoms what do you think I can possibly have? The urologist said if it doesn't clear up I could have something called "Prostatitis", however I was checked a few weeks back in another clinic (after the burning sensation started) and my prostate wasn't inflamed -- which I think is the main symptom?

I am worried sick about this and just want to get to the bottom of what's causing this. Thanks for any help / insights you can offer!


21 months ago
Sorry just another piece of info is that the spa therapist I had sex with (which triggered the symptoms 3 days after as described in my previous question) has now been tested, and tested negative for all STDs (blood+urine). The spa invited me there to see the results, so I don't think they're lying.

I'm so confused now
Edward W. Hook M.D.
Edward W. Hook M.D.
21 months ago
Welcome back to the Forum. On this occasion I happened to pick up your question.  In preparing to provide an answer I reviewed your earlier interaction with Dr. Handsfield and agree with his assessment at the time. The additional information that you have received regarding your therapist makes my confidence in his assessment even greater.  This is not an STI and is far more likely to reflect your own guilt and increased focus on any possible genitourinary symptoms than an STI acquired from the exposure you describe.  The signs and symptoms you describe do not suggest STI.

In answer to your specific questions:
1. I had a HIV test done 9 days after that occurrence which came back negative. Do you think I need to worry still about HIV being a cause for my symptoms? I didn't have any fever so far. 
A 9 day HIV test is too early to provide reliable results.  HIV tests at 28 days will detect over 99% of recent infections and any test take after more than 6 weeks will be definitive.  Having said that, none of the symptoms you report are at all suggestive of HIV. Further, I presume that the tests your partner had included HIV and if those were negative, you could not have gotten HIV from her.
2.  The "empiric therapy" you received was likely therapy for gonorrhea.  Gardnerella is a normal genitourinary bacteria and its detection is not significant and does not warrant treatment. I would not anticipate that the metronidazole would be helpful but it could result in gastrointestinal upset.  Your symptoms are most suggestive of anxiety and are not suggestive of prostatitis.

I urge you to accept that you did not get an STI from the events you described. EWH
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21 months ago
Thanks Doctor.  I accept your suggestion this is not an STI.

After reading your answer I went on google again to research some of my specific symptoms, such as the red tip of my penis. 

I then found a term I had not seen before: balanitis — this actually sounds very much in line with what I felt in the start (burning groin) and to this day (red dots while erect and constant warm/burning sensation)..

- Could this be a plausible diagnosis in your view?

Thank you

Edward W. Hook M.D.
Edward W. Hook M.D.
21 months ago
Please be careful with Google.  In matters related to sexual health it is typically not your friend, pointing all too often to HIV or STIs as a potential cause of just about everything.  Unfortunately, much of what is found with Google questions of this sort is out of date, taken out of context, over interpreted or just plain wrong.

Balanitis is a descriptive term for inflammation of the head of the penis.  Most typically it involves the entire head of the penis as opposed to only the urethra and area immediately surrounding it.  The redness of the tip of your penis could be mild balanitis and because of the inflammation (the suffix "-itis" means inflammation) this could lead to irritation on urination.  If it is balanitis, it is not an STI and antibiotics would potentially make it worse, not better since most infectious balanitis is due to fungal infections.   EWH
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20 months ago
Hi Doctor -- it's been around 2 weeks since your last reply and I wanted to give you an update and ask one final question.

I've seen a few more doctors and have been taken mecinazole cream to treat the Balinitis, the burning sensation / redness has gotten a bit better but effects are lingering -- the doctors here in the Philippines seem to suggest to do a circumcision as my foreskin is quite long which "may" help to speed up recovery....

However, given the fact the symptoms don't seem to go away, I've inevitably starting worrying again and my mind wonders if it might still be an STI causing this -- also, and I don't know what this means -- my lips have started to tingle since about 5 days ago and I'm now developing what seems like a cold sore. Could I have herpes? I haven't been tested for this, but 4 different doctors examined my groin area and didn't even ask for tests for this?? 

It's been 6 weeks since the initial onset of the symptoms and have not had sex -- or anything sexual -- in that time. It's weird this only starts now? Is this just coincidental?

Thanks 


20 months ago
Just to show you, these are the sores on my mouth https://www.dropbox.com/s/cgifnlfne06w1ya/Personal.png?dl=0
Edward W. Hook M.D.
Edward W. Hook M.D.
20 months ago
The additional information in no way changes my opinion or assessment.  It is too late for you to be developing a cold sore from your exposure well over a month ago.  If you are developing a cold sore, which I doubt, this is a function of prior infection.  It really is far past time for you to stop worrying about your misstep and move forward.  If you continue to see doctors, some of them will try things which put you at risk for side effects and complications.

As this is my 3rd response, this completes this thread.  I must also point out to you that further repetitive, anxiety-driven questions may be deleted without a response and without return of your posting fee.  If you cannot control the concerns that you express here and which have taken you to multiple health care providers, I would suggest seeking counseling from a trained mental health provider, not more doctors or drugs.  I make this suggestion out of concern for you, nothing more.  You do not have an STI from the exposure you have described.  EWH



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